Arizona Priority Care

What Arizona Priority Care does

Arizona Priority Care (AZPC), operating under the legal entity Arizona Health Advantage Inc., is a physician-led medical management organization headquartered in Chandler, Arizona, founded in 2012 as an affiliate of Heritage Provider Network (HPN, established 1979 by Dr. Richard Merkin). The company operates as an intermediary between Medicare Advantage and Medicaid health plans and a contracted network of 1,200+ primary care physicians, specialists, hospitals (including Banner Health and HonorHealth), and ancillary providers across Maricopa, Pinal and Pima counties, coordinating value-based care for enrolled Medicare Advantage beneficiaries and traditional Medicare FFS beneficiaries under the CMS ACO REACH model.

AZPC's core technology stack consists of provider-facing web portals — AZ Connect (eligibility verification, claim status, prior authorization, member risk and quality data), EZ-Net (prior-authorization tracking, Okta-authenticated), and qHMO (STARS/HEDIS quality metrics and member management) — integrated with Office Ally for 837P/837I electronic claims submission under Payor ID AZPCP. Service offerings include Complex Care Management, Telephonic Care Management, Palliative Care, Social Services, Home Wellness (annual in-home NP visits), Transitional Care, Pharmacy Assistance, Medicare Risk Adjustment / HCC coding support, STARS quality initiatives, credentialing under NCQA standards (re-credentialing every 36 months), claims processing (typically 1-2 days for electronic claims), and utilization management with a 24-hour physician hotline.

Commercially, AZPC generates revenue through risk-adjusted capitation payments from contracted Medicare Advantage plans (Alignment Health Plan, Blue Cross Blue Shield of Arizona, eternalHealth, SCAN Health Plan, Aetna, WellCare by AllWell), performance-based quality incentive payments tied to STARS and HEDIS measures, REACH ACO shared savings (e.g., $332,950.94 in DCE shared savings for Performance Year 2022), and care coordination fees for transitional, complex and in-home wellness services. The company employs 51-100 corporate staff, has no publicly disclosed revenue or external funding, and reports a 100% Total Quality Score for ACO REACH Performance Years 2021, 2022 and 2023 alongside a contracted Direct Referral Program in which 80% of consultation referrals are sent directly from PCP offices.

Name

Arizona Priority Care

Legal name

Arizona Health Advantage Inc.

Website

https://azprioritycare.com

Company type

Private

Founded year

2012

Operating status

Operating

Headcount range

51–100 employees

Short description

Arizona Priority Care is a physician-led medical management organization based in Chandler, Arizona, operating as an affiliate of Heritage Provider Network. It delivers value-based care coordination, risk adjustment, and care management through a contracted network of 1,200+ providers under contracts with Medicare Advantage health plans across Maricopa, Pinal and Pima counties.

Ownership category

akta.pro rank

Product category

Value-Based Healthcare Network Management

NAICS

Services for the Elderly and Persons with Disabilities (624120), Agencies, Brokerages, and Other Insurance Related Activities (5242), Nursing and Residential Care Facilities (623)

SIC

Services-Offices & Clinics Of Doctors Of Medicine (8011), Services-Home Health Care Services (8082), Hospital & Medical Service Plans (6324)

akta.pro industry

PRIMARYHLAFAGAF

Value-Based Primary Care Organizations (Risk-Bearing)

Healthcare & Life Sciences/Healthcare Providers & Systems/Primary Care & Community Health Providers

SECONDARYFSAIAGAK

Medicare Provider Networks & Delegated Medical Groups (MA-focused)

Financial & Insurance/Insurance — Life & Health/Medicare Advantage & Medicare Supplement (Medigap)

SECONDARYFSAIAGAL

Medicare Member Engagement & Care Management (Utilization, Case/Disease Mgmt)

Financial & Insurance/Insurance — Life & Health/Medicare Advantage & Medicare Supplement (Medigap)

SECONDARYHLAEALAG

Care Management & Population Health Program Administration

Healthcare & Life Sciences/Health Insurance & Managed Care/Third-Party Administration (TPA) & Administrative Services Only (ASO)

SECONDARYHLAEAMAI

Medicaid Managed Care HMOs

Healthcare & Life Sciences/Health Insurance & Managed Care/Health Maintenance Organizations (HMOs)

Keywords

• Value-based care
• Medicare advantage network
• Care coordination services
• Physician network management
• Accountable care organization

Headquarters

HQ city

Chandler

HQ country

United States

HQ region

North America

Offices2 records

Markets served

GTM type

B2B

Offering type

Services

Cost components

Personnel, Operations, Technology or R&D, Marketing or Sales, Infrastructure

Revenue model

1. Capitation Payments: AZPC receives capitation payments from contracted health plans (Medicare Advantage, Medicaid) for coordinating care to enrolled members. Payments are risk-adjusted based on member health status (HCC model).
2. Quality Incentive Payments: Performance-based payments from health plans tied to STARS ratings, HEDIS measures, and quality metrics. Includes quarterly incentive bonuses paid to providers.
3. REACH ACO Shared Savings: AZPC participates in ACO REACH model, sharing savings/losses based on quality and cost performance for traditional Medicare beneficiaries. Historical results show $332,950.94 DCE shared savings in 2022.
4. Care Coordination Fees: Fees received from health plans for care coordination services including transitional care, complex care management, and in-home wellness assessments.

Pricing tiers

Go-to-market motion2 records

Distribution channels3 records

Marketing channels6 records

Core offering

Arizona Priority Care operates a physician-led medical network that contracts with Medicare Advantage, Medicaid, and traditional Medicare health plans to deliver coordinated, value-based healthcare through a contracted network of primary care physicians, specialists, and ancillary providers across Arizona. The company provides care coordination programs (Complex Care Management, Transitional Care, Palliative Care), manages provider credentialing, claims processing, prior authorization, and risk adjustment (HCC) services, and operates an REACH ACO for traditional Medicare beneficiaries. AZPC earns revenue primarily through capitation payments, quality incentive bonuses, and shared savings arrangements with contracted health plans.

Product overview

Arizona Priority Care (AZPC) operates as a physician network/medical group that partners with Health Plans to deliver coordinated healthcare. The company offers a platform of provider-facing portal tools including AZ Connect, EZ-Net, and qHMO for eligibility verification, claims processing, and prior authorization management. Care management services include Complex Care Management, Telephonic Care Management, Palliative Care, and Social Services, alongside patient programs such as the Home Wellness Program, STARS quality initiative, and Pharmacy Assistance. AZPC also administers the REACH ACO for Traditional Medicare beneficiaries and manages provider credentialing and utilization review processes.

Differentiator

Problem solved

Functional benefit

Products and services

• AZ Connect Secure physician portal providing network providers with access to member eligibility verification, claims status checking, prior authorization submission and tracking, and patient medical history for AZPC members.
• EZ-Net Provider portal for checking prior authorization request status, requiring Okta login authentication, used by network providers to track and submit prior authorization requests.
• qHMO Portal Provider portal for managing qHMO-related functions and member information, including STARS quality measures tracking and member management capabilities.
• Complex Care Management (CCM) Program assisting primary clinicians with managing patients who have multiple and complex medical conditions through home visits by Registered Nurse Care Managers and Licensed Clinical Social Workers, creating personalized care plans.
• Telephonic Care Management (TCM) Program for members requiring less intensive interventions, providing referrals to community resources, physician referrals, and monthly nurse check-ins over the phone to encourage wellness.
• Palliative Care Program Program focused on controlling pain and symptoms related to chronic disease conditions through a team including Nurse Practitioners, RNs, LPNs, CNAs, Social Workers, and Chaplains.
• Social Services Program Provides information, resources, and ongoing support including assistance with Advance Directives, Medicaid applications, Long Term Care Services, and social-related needs and resources.
• Transitional Care Services Coordinates care during transitions between healthcare settings or to home, involving Nurse Practitioners who schedule follow-ups, review medications, perform assessments, and provide community resources.
• Home Wellness Program Coordinates Medicare-covered home health services including skilled nursing care, physical therapy, speech-language pathology, and occupational services, and includes annual wellness visits conducted at home by Nurse Practitioners.
• Medicare Risk Adjustment Services Supports providers with HCC (Hierarchical Condition Category) coding, medical record documentation education, member chart reviews, peer-to-peer education, and annual education programs to optimize risk adjustment scores.
• STARS Program Quality improvement initiative designed to improve population health, assist providers, and reduce healthcare costs through integrative value-based healthcare delivery using advanced technology and HEDIS measures tracking.
• Minute Clinic Partnership Service Walk-in services for minor illnesses and skin conditions at select CVS Minute Clinic locations without requiring prior authorization, with visit reports forwarded to members' primary care physicians.
• Pharmacy Assistance Program Pharmacy team provides complete medication reviews, addresses medication concerns, finds cost-reduction options, and reviews post-hospitalization medications to maximize medication benefits.
• AZPC REACH ACO Realizing Equity, Access, and Community Health accountable care organization working with Medicare fee-for-service beneficiaries to deliver high-quality, affordable, and equitable care through network physicians, with voluntary patient alignment.
• Prior Authorization Services Handles prior authorization reviews for hospital admissions and specialty services, including outpatient services, with a 24-hour physician hotline for peer-to-peer review of emergent authorizations.
• Claims Processing Services Processes both electronic and paper claims submissions from providers, with electronic claims typically processed within 1-2 days of receipt, integrated through Office Ally with Payor ID AZPCP for 837P/837I submissions.
• Provider Credentialing Services Verifies provider qualifications, licenses, and professional background for Medicare Advantage plan participation, adhering to NCQA standards with re-credentialing required at least every 36 months.

Quantifiable outcome

• 100% Total Quality Score achieved for ACO REACH Performance Years 2021, 2022, and 2023
• +5 more outcomes

Named customers6 records

Segments4 records

Ideal customer profiles3 records

Technology focussed No

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Integration1 record

Feature4 records

Partnerships

Twelve partnerships are on record, tiered core and minor.

• Heritage Provider NetworkcoreStrategic or Co-development PartnerAZPC is an affiliate of Heritage Provider Network (HPN), established in 1979 by founder Dr. Richard Merkin. HPN provides strategic guidance, operational infrastructure, and shared services to AZPC. The parent company has been a pioneer in healthcare delivery for over 30 years, primarily in California and New York.
• Alignment Health PlancoreChannel Partner/ Reseller/ DistributorMedicare Advantage plan with fully delegated arrangement where AZPC handles network management, credentialing, claims, and care coordination for enrolled members in Maricopa County.
• Blue Cross Blue Shield of ArizonacoreChannel Partner/ Reseller/ DistributorBCBSAZ transitioned to fully delegated arrangement with AZPC as of 4/1/2024, covering Maricopa & Pinal County members for Medicare Advantage plans.
• eternalHealthcoreChannel Partner/ Reseller/ DistributorMedicare Advantage plan fully delegated to AZPC for provider network services serving members in Maricopa & Pima County.
• SCAN Health PlancoreChannel Partner/ Reseller/ DistributorMedicare Advantage plan with fully delegated arrangement covering Maricopa, Pinal, & Pima County. AZPC manages network operations and care coordination for SCAN members.
• AetnaminorChannel Partner/ Reseller/ DistributorValue-based arrangement where AZPC provides coordinated care services for Aetna Medicare members.
• WellCare by AllWellminorChannel Partner/ Reseller/ DistributorValue-based Medicare Advantage partnership through which AZPC delivers care coordination services to WellCare members.
• CVS Minute ClinicminorStrategic or Co-development PartnerAZPC partnered with Minute Clinic in select CVS stores to provide walk-in services for minor illnesses, skin conditions, and travel health. No authorization required; reports forwarded to primary care physician.
• Dispatch HealthminorStrategic or Co-development PartnerAt-home urgent care service provider partnership allowing AZPC members to receive urgent medical care in their homes, integrated with care coordination services.
• NextCareminorChannel Partner/ Reseller/ DistributorUrgent care provider network partnership providing AZPC members access to walk-in urgent care services at NextCare locations.
• The Michael J. Fox FoundationminorStrategic or Co-development PartnerAZPC partnered with The Michael J. Fox Foundation to bring awareness to the Parkinson's Progression Markers Initiative (PPMI), supporting brain health research and patient education.
• CMS REACH ACO ProgramcoreStrategic or Co-development PartnerAZPC participates in the ACO REACH (Realizing Equity, Access, and Community Health) model, a CMS innovation initiative where healthcare providers work together to improve Medicare quality and equity outcomes.

Scale indicators8 records

Recent moves9 records

Expansion highlights6 records

Direct peers

• Privia Health Group: Multi-payer, multi-state medical-group platform that signs single-signature payer contracts, provides care coordination, and embeds population health technology into independent practices — a direct functional analog to AZPC's delegated MA platform at a larger, public scale.
• agilon health: Public VBC enabler that partners with primary care physicians under global-cap and full-risk MA arrangements; comparable to AZPC in revenue model (capitation + shared savings), clinical focus (senior MA lives), and use of PCP enablement technology to drive STARS/HEDIS performance.
• P3 Health Partners: VBC operator focused on MA seniors in the Western U.S. (notably Arizona, Nevada, California, Florida) with delegated payer contracts, capitation revenue, and risk-adjustment-driven operating model — a direct Arizona market peer to AZPC.
• Astrana Health (formerly Apollo Medical Holdings): Public risk-bearing IPA/MSO that contracts with MA plans, runs delegated networks, and operates ACO REACH — directly comparable to AZPC in business model (capitation, delegated payer services, quality incentive programs) and patient population (MA seniors).
• Heritage Provider Network: AZPC's parent organization and the closest direct analog: a physician-led, risk-bearing medical group/IPN that contracts with MA and ACO payers in California and New York using the same value-based, delegated, HCC/STARS-driven operating model that AZPC replicates in Arizona.

Emerging players

• Cano Health: Senior-focused VBC primary care operator with significant Florida exposure and select Southwest markets; uses a similar MA capitation + risk-adjustment + STARS-driven model and competes for delegated MA memberships in geographies overlapping with AZPC's footprint.

Broad incumbents

• VillageMD (Walgreens Boots Alliance / Summit Health): Large primary-care and value-based care platform that contracts with MA plans and ACOs and operates risk-bearing practices — overlapping with AZPC in value-based MA primary care delivery and population health enablement.
• Oak Street Health (CVS Health): National senior-focused VBC primary care operator (now owned by CVS Health) serving MA populations; comparable to AZPC's MA-only, PCP-led, risk-bearing model but at significantly larger scale and with employed (rather than affiliated) providers.
• Optum Health (UnitedHealth Group): Largest U.S. operator of risk-bearing, MA-focused physician groups and IPA networks; competes with AZPC in the same delegated-MA value-based care category, though at vastly larger national scale and with owned-payer alignment.

Others

• HonorHealth (Arizona): Large Arizona health system that is itself a participant in AZPC's preferred provider network; included as a regional ecosystem participant that both supplies and competes for value-based MA lives in AZPC's core Arizona counties.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat5 records

Key risks7 records

Key highlights7 records

Customer concentration

Revenue estimate

Valuation estimate

Number of profiles

Profiles7 records

Funding overview

Funding rounds

Investors

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about Arizona Priority Care